Kaiser Daily Global Health Policy Report

In The News

“The U.S. Senate passed legislation [.pdf] on Monday to extend for another five years a successful and popular program to combat AIDS worldwide started 10 years ago by former President George W. Bush,” Reuters reports. The Senate approved the PEPFAR Stewardship and Oversight Act by unanimous voice vote, according to the news agency. “The measure was introduced in the Senate … by Senators Robert Menendez, Democratic chairman of the Senate Foreign Relations Committee, and Bob Corker, its top Republican,” Reuters notes (Zengerle, 11/18).

“The measure now heads to the House, where it is expected to pass easily,” the Associated Press reports (Cassata, 11/18). In the House, “floor debate will be limited, and a two-thirds majority support will be required for [the bill] to pass, reflecting the expectation from leaders that the measure will face little opposition,” National Journal states. The news service also describes specific “provisions and reporting requirements to strengthen oversight of the program” contained in the bill (House, 11/18). Additional information on the bill is available from the Kaiser Family Foundation’s “Policy Tracker” (11/18).

“Some 2.5 billion people do not have access to adequate sanitation, the United Nations said, and more than one billion practice open defecation — a problem that contributes to countless deaths from preventable diseases,” the Associated Press reports, noting World Toilet Day is observed November 19. “Each year, more than 800,000 children under five die from diarrhea, the U.N. said, many due to poor sanitation,” the AP writes. “We must break the taboos and make sanitation for all a global development priority,” U.N. Secretary-General Ban Ki-Moon said, according to the news agency (Spielmann, 11/19). “Diarrheal diseases, stemming from improper sanitation, are the second-leading cause of deaths — respiratory diseases are first — among the young in developing countries,” according to CNBC/NBC News, which adds, “The [WHO] estimates that at any given moment, half of the developing world’s people are sick from diseases associated with dirty water and bad sanitation” (Koba, 11/15).

“The Philippines will divide up the typhoon-ravaged central Visayas between countries to maximize relief efforts, a senior officer said, as President Benigno Aquino won guarded praise for improving aid distribution 11 days after the storm hit,” Reuters reports. “But the country is still struggling to get aid to devastated areas due to the extent of the destruction, which has left four million people displaced, threatening Aquino’s reforms that have helped transform the Philippines into one of Asia’s fastest-growing and hottest emerging economies,” the news agency adds (Mogato, 11/19). However, “[m]edical care is finally beginning to improve nearly a week and a half since the typhoon struck the east-central Philippines, with 62 foreign or Filipino medical teams now working in areas with the most damage,” according to the New York Times (Bradsher, 11/18).

“WHO is continuing to coordinate the deployment of foreign medical teams with an immediate focus on injured and traumatized survivors and an eye towards the people’s longer-term health needs,” according to a press release from the agency (11/19). “The head of U.N. disaster relief visited the heart of the Philippine disaster zone on Tuesday and stressed the need for long-term planning as well as emergency relief to ensure farmers and fishermen can resume their livelihoods,” Reuters writes in a separate article (McDill, 11/19). The Associated Press/Huffington Post’s “World” blog examines efforts to care for newborns in the wake of the typhoon (Pitman, 11/19).

The Christian Science Monitor examines polio vaccination efforts in Syria, writing, “[W]ith at least 10 recent confirmed cases of the paralyzing virus, international health workers are worried about a regional outbreak of the virus, particularly given the constant flow of Syrians to neighboring countries.” The news service writes, “Doctors and nurses are giving polio vaccinations to every child registered with the United Nations in Syria’s neighbors, which now host 2.2 million Syrian refugees” (Collard, 11/18). VOA News reports on vaccination efforts in Egypt. The country “was declared polio free in 2006,” but “the same strain of virus causing illness in Syria was found in Cairo’s sewers” last year, the news service notes (Arrott, 11/18). In addition, “Turkey on Monday announced a mass vaccination campaign against an outbreak of polio in areas near neighboring Syria,” according to Agence France-Presse, which writes, “Polio was eradicated in Turkey 15 years ago but the country, which is home to more than 600,000 Syrian refugees, could be at risk from the outbreak of the disease” (11/18).

“Efforts to stop the spread of polio in the Horn of Africa region are being ramped up with major immunization campaigns underway, targeting millions of vulnerable children,” IRIN reports. “There have been outbreaks in Kenya and Ethiopia, and more seriously neighboring Somalia, with 183 cases confirmed this year up to October, according to a snapshot by the U.N. Office for the Coordination of Humanitarian Affairs (OCHA),” the news service notes, adding, “If the polio outbreak in Somalia is not controlled quickly, global efforts to wipe out the disease once and for all could be jeopardized, warned the U.N. Children’s Fund [UNICEF].” IRIN also highlights efforts to vaccinate children in South Sudan and Sudan (11/18).

“China will further ease its family planning laws after announcing last week that it would allow millions of families to have two children, a senior official from the government’s family planning commission said on Tuesday,” Reuters reports. In “the most significant relaxation of the one-child policy in nearly three decades,” officials last week announced the government “would allow couples in which one of the parents is an only child to have a second child,” the news agency notes. “Further easing of the laws could mean allowing all families to have two children, although the health ministry said … that could be disruptive,” Reuters writes. In a statement, health ministry Deputy Director Wang Peian said, “The basic policy of family planning will need to be upheld over the long term and we cannot rest up on this,” according to the news agency (Wee, 11/19).

“A common type of malaria that used to be powerless to infect certain groups of Africans is becoming more potent, putting tens of millions of people at risk, scientists said Friday,” Agence France-Presse/GlobalPost reports (11/15). “Now roughly 95 percent of people in sub-Saharan Africa — where the malaria burden is the highest — are thought to be resistant to the parasite in question, Plasmodium vivax,” but “[t]wo new genetic studies of [P. vivax] suggest that it may be evolving new ways to invade human blood cells,” Science Now writes (Vogel, 11/15). Researchers presented the findings from two studies on Friday at a conference of the American Society of Tropical Medicine and Hygiene, the New York Times notes. “If vivax can establish itself in Africa, it can really undo a lot of the malaria progress we’ve made,” Peter Zimmerman, a malariologist from Case Western Reserve University who worked on one of the studies, said, according to the newspaper (McNeil, 11/18).

“Global spending on prescription medicines will accelerate next year to exceed $1 trillion for the first time, fueled by the launch of more innovative drugs and rising health expenditure in emerging markets led by China,” the Financial Times reports. The projections were made by the IMS Institute for Healthcare Informatics, according to the newspaper. “Two-thirds of the total medicines market in 2017 will be accounted for by the eight markets of the U.S., France, Germany, the U.K., Italy and Spain, as well as China and Japan, which will also be responsible for nearly 60 percent of the total growth in spending,” the newspaper writes (Jack, 11/19).

The Financial Times examines how the deaths of seven female participants of a study on the cost and feasibility of incorporating human papillomavirus (HPV) vaccines “into India’s public sector immunization program” has affected opinions of drug trials in the country. “[T]he program to vaccinate 14,000 adolescent girls from poor families ran into trouble after seven died soon after their vaccinations,” the newspaper notes. Though “[t]he causes of the girls’ deaths were never established or conclusively linked to the HPV vaccine … serious questions were raised over whether the participants’ parents — many of whom were illiterate — had given informed consent, and whether the project adequately tracked any adverse reactions,” the newspaper writes, adding, “The ensuing media and political storm — highlighting sensitivities around drug trials in the developing world — has contributed to the restrictions on such studies, affecting both Indian and global pharmaceutical companies” (Kazmin, 11/18).

IRIN examines the ongoing humanitarian situation in South Sudan. “The 2014-2016 Consolidated Appeals Process (CAP) for South Sudan reflects an improving humanitarian situation amid a slowdown in the arrival of new refugees and returnees from Sudan and overall improvements in food security, says a senior U.N. official,” the news service writes, adding, “However, a significant proportion of the South Sudanese population still needs food and livelihood support as well as clean water, sanitation and health assistance.” The news service discusses humanitarian needs in the country, which “is home to an estimated 225,557 refugees, according to [the U.N. Office for the Coordination of Humanitarian Affairs (OCHA)],” and notes, “South Sudan has also been grappling with internal conflict in Jonglei State, as well as natural disasters” (11/15).

Indonesia this week recorded its 163rd fatality from H5N1 avian influenza, with the death of a 31-year-old woman, Agence France-Presse reports (11/18). “She is the third Indonesian to die this year from the virus,” according to the Associated Press/ABC News, which adds, “An investigation by the ministry found that the woman, who first developed symptoms of fever and nausea on November 1, had possible contact with poultry around her house” (11/18).

Editorials and Opinions

“We are making historic progress against HIV/AIDS … [y]et AIDS remains the leading cause of death in sub-Saharan Africa,” Desmond Tutu, archbishop emeritus of Cape Town and honorary chair of endgame, writes in a Politico opinion piece. “President Barack Obama should be commended for uniting the world behind the goal of creating an AIDS-free generation,” he states, adding, “[T]here are two decisions Obama can make before the end of this year to fulfill the promise of an AIDS-free generation.” Tutu continues, “The first is to commit to doubling the number of people receiving antiretroviral treatment through [PEPFAR],” and “[t]he second decision Obama could make concerns America’s role in expanding access to antiretrovirals through the Global Fund to Fight AIDS, Tuberculosis and Malaria.” “I hope the president will agree to provide up to one-third of the total Global Fund’s donations — up to $5 billion — over the next three years,” he writes, concluding, “We can defeat this disease and create an AIDS-free generation over the next decade if we remain focused and driven” (11/18).

“More than one-third of the world’s population, approximately 2.5 billion people, doesn’t have access to a toilet,” Jason Kass, founder of Toilets for People, writes in a New York Times opinion piece. “Poor sanitation contributes to 2,000 childhood deaths from diarrheal diseases every day,” he notes, adding, “Unfortunately for … the millions of people who live on marginal, waterlogged land, there are no cheap solutions available. What they need are the kind of toilets that they can buy or build with a few weeks’ savings.” Kass says, “Ecological toilets that use natural composting to break down waste are simple to construct, waterless and are easy to fix,” but “they’re too expensive, with price tags of over $1,000.” He notes his organization and others are developing low-cost versions. “If we embrace these low-tech toilets, we’ll be on the right track to getting 2.5 billion people one step closer to a safe, clean, comfortable and affordable toilet of their own. That’s something worth celebrating this World Toilet Day,” Kass concludes (11/18).

The following is a summary of two opinion pieces in the Washington Post addressing the post-typhoon humanitarian response in the Philippines.

Lauren Prather: In the newspaper’s “The Monkey Cage” blog, Prather, a PhD candidate in Stanford University’s Department of Political Science, examines whether the U.S. should provide aid in the form of money or food. “The answer could depend on agricultural interests in the United States: People from food-producing states may prefer giving food to giving cash,” she writes, noting proposed changes to the U.S. Food for Peace program. She discusses the results of a survey she administered to a representative sample of 1,000 Americans in July. “First, it appears that when it comes to domestic anti-poverty policies in the United States, Americans have a strong preference for food aid over cash aid,” she writes, adding, “Second, this preference for giving in-kind aid instead of cash aid does not translate to the foreign context. Finally, my study suggests that segments of the population with a stake in the way food aid is distributed may have preferences that differ from those of the general public” (11/18).

Vijaya Ramachandran and Owen Barder: “Relief and reconstruction efforts in the Philippines have much to learn from previous mega-disasters, including, most recently, the massive earthquake in Haiti in 2010,” Ramachandran, a senior fellow at the Center for Global Development (CGD), and Barder, a senior fellow and the director of the CGD in Europe, write. They discuss challenges faced in the humanitarian response in Haiti, and state, “The international community can and must do better in the Philippines, and there is reason to be hopeful.” They write, “To make that aid effective, and to ensure that it reaches the people who need it, donors, starting with the United States, should commit to full and rapid transparency,” adding, “The international community must embrace the technology available to strengthen disaster preparedness, resilience and aid” (11/15).

“A crisis looms. In the very near and rapidly approaching future, the wonder-drugs of the 20th century, antibiotics, may cease to be useful,” a Lancet Infectious Diseases editorial states. “Against this bleak backdrop, the global activities of Antibiotic Awareness Week, starting November 18, seek to draw attention to a dire situation that threatens to take us back to a preantibiotic era,” according to the editorial. “For our part, the Lancet Infectious Diseases launches a Commission, entitled ‘Antibiotic resistance — the need for global solutions,'” the editorial notes, adding, “[T]he Commission explores why antibiotic resistance has become such a problem worldwide, and, most importantly, proposes solutions to avert the impending crisis.” The editorial describes the topics the Commission will highlight, and it concludes, “To maintain and build on current interest, antibiotic resistance should feature prominently in discussions of post-2015 development goals. We hope that the Commission will provide encouragement that, although the picture is bleak, there is hope” (December 2013). The current issue of the Lancet Infectious Diseases contains several articles addressing antibiotic resistance (December 2013).

In a Foreign Policy opinion piece, Daniel Altman, a teacher of economics at New York University’s Stern School of Business and chief economist of Big Think, examines how the relaxing of China’s one-child policy might affect the demographic and economic projections in the country. He discusses China’s aging population, the possibility of an increase in unemployment, the potential for declines in health indicators, and other potential changes. “Early reports suggest that the transition will be gradual, so some of these risks might be finessed,” Altman writes, concluding, “But even if the eventual abandonment of China’s limits on childbearing led to an additional 10 million births a year, as the government’s own estimates have suggested it might, the long-term effects on the economy would be decidedly mixed” (11/18).

Noting “[m]ore than 15 million babies are born before 37 weeks of pregnancy every year, and one million of those babies die before they are one month old,” March of Dimes Foundation President Jennifer Howse writes in the Huffington Post’s “Global Motherhood” blog, “November 17 was the third annual World Prematurity Day and organizations from around the world joined the March of Dimes to call attention to this global problem and what can be done to prevent it.” She continues, “About 75 percent of the babies who don’t survive their early birth could have been saved using two simple, low-cost treatments called antenatal steroids and Kangaroo Care,” which is “when a newborn baby is placed directly on the mother or father’s chest.” Howse writes, “Societies need to make the same kinds of commitment to their health care systems that parents make in caring for their children. World Prematurity Day gives those of us in health care a clear call to make that commitment” (11/18).

Recent Releases

“On World Toilet Day, [observed Tuesday,] we’d like to take a moment to celebrate the toilet for not only saving lives — by reducing the risk of deadly diarrhea — but also for helping people to grow taller, a key measure of childhood malnutrition,” Victoria Fan, a research fellow at the Center for Global Development (CGD), and Rifaiyat Mahbub, a research assistant at the center, write in the CGD “Global Health Policy” blog. They highlight two research papers examining the relationship between sanitation, malnutrition and height. “Toilets, diarrhea, height and weight, and mortality are interrelated, though scientific evidence of the precise direction and mechanism of these causal pathways will not be easy to disentangle,” they state, concluding, “[Toilets] not only save millions of children, but they make them healthier and taller too” (11/18).

“In Istanbul, Turkey, a city where East meets West, and emblematic of our challenge to meld state-of-the-art science with age-old parental instincts to provide newborn children with food, warmth and love, a group came together on [October 21-23] to ‘bend the curve’ on newborn survival through acceleration of adoption of Kangaroo Mother Care (KMC),” Mariam Claeson, interim director of maternal, newborn, and child health on the Bill & Melinda Gates Foundation’s family health team, and colleagues write in the foundation’s “Impatient Optimists” blog. “If universal KMC coverage was achieved, it is estimated that it could save on the order of 450,000 preterm newborns each year,” they state, adding, “Paramount to our success will be our ability to unify around clear goals, targets, and indicators” (11/18).

“Many of the conversations and discussions that took place [at the International Conference on Family Planning] centered on the use of mobile technology as a medium for creating greater access to family planning information and resources,” Diane Fender, vice president and blogger at Girls’ Globe, writes in the Bill & Melinda Gates Foundation’s “Impatient Optimists” blog. She discusses Kenya’s use of ZIDI, “an innovative mobile application that improves the monitoring and evaluation of health services, including family planning, in dispensaries and clinics.” She concludes, “The ZIDI project is definitely making strides to bring innovation and new technology to help health care workers provide better service to women seeking family planning services” (11/18).